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B-cell acute lymphoblastic leukemia with t(4;11)(q21;q23) in a young woman: evolution into mixed phenotype acute leukemia with additional chromosomal aberrations in the course of therapy.

Carulli G, Marini A, Ferreri MI, Azzarà A, Ottaviano V, Lari T, Rocco M, Giuntini S, Petrini M - Hematol Rep (2012)

Bottom Line: Karyotype showed the co-existence of three cell lines, with persistence of t(4;11)(q21;q23) and appearance of +8,+12,+13 and two der(4).The patient died because of disseminated intravascular coagulation.This finding suggests a blast cell derivation from a common lymphoid/monocytic precursor leading to a final bilineal acute leukemia.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa;

ABSTRACT
About 5% of adult B-cell acute lymphoblastic leukemias (B-ALL) are characterized by t(4;11)(q21;q23), which confers peculiar features to this B-ALL subtype, including a very immature immunophenotype and poor prognosis. We describe the case of a 21-year-old female who presented with B-ALL carrying the t(4;11)(q21;q23) and blasts positive for CD19, TdT, CD79a, CD38, HLA-DR. Before completing the Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) therapy regimen, the B-cell leukemic clone still was detected, but an additional leukemic clone appeared, with morphology and immunophenotype (CD13, CD33, CD64, CD38, CD56, CD15, CD4(dim)) compatible with derivation from the myeloid/monocytic lineage. Karyotype showed the co-existence of three cell lines, with persistence of t(4;11)(q21;q23) and appearance of +8,+12,+13 and two der(4). The patient died because of disseminated intravascular coagulation. Our report describes a rare, possible evolution of such a subtype of B-ALL, with transformation into mixed phenotype acute leukemia in the course of therapy. This finding suggests a blast cell derivation from a common lymphoid/monocytic precursor leading to a final bilineal acute leukemia.

No MeSH data available.


Related in: MedlinePlus

Immunophenotype of blasts at diagnosis in peripheral blood samples. A) CD45/SSC dot-plot. Blasts are included in P1 population. B) blasts are CD19-positive, with a minority of them (18%) being CD34-positive (Q2 quadrant). Blasts are CD10- and CD20-negative (C) and CD58-positive (D). E) positivity of CD79a. F) blasts are negative for CD13.
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Figure 2: Immunophenotype of blasts at diagnosis in peripheral blood samples. A) CD45/SSC dot-plot. Blasts are included in P1 population. B) blasts are CD19-positive, with a minority of them (18%) being CD34-positive (Q2 quadrant). Blasts are CD10- and CD20-negative (C) and CD58-positive (D). E) positivity of CD79a. F) blasts are negative for CD13.

Mentions: Manual WBC differential count of peripheral blood showed 90% blasts without morphologic differentiation (Figure 1A), 2% neutrophils, 8% small lymphocytes. Blasts resulted negative for myeloperoxidase stain. Flow cytometric analysis was therefore performed using a wide monoclonal antibody panel and a six-color method: blasts were positive for CD19, TdT, CD79a, CD38, CD58, HLA-DR (Figure 2A–F).


B-cell acute lymphoblastic leukemia with t(4;11)(q21;q23) in a young woman: evolution into mixed phenotype acute leukemia with additional chromosomal aberrations in the course of therapy.

Carulli G, Marini A, Ferreri MI, Azzarà A, Ottaviano V, Lari T, Rocco M, Giuntini S, Petrini M - Hematol Rep (2012)

Immunophenotype of blasts at diagnosis in peripheral blood samples. A) CD45/SSC dot-plot. Blasts are included in P1 population. B) blasts are CD19-positive, with a minority of them (18%) being CD34-positive (Q2 quadrant). Blasts are CD10- and CD20-negative (C) and CD58-positive (D). E) positivity of CD79a. F) blasts are negative for CD13.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475937&req=5

Figure 2: Immunophenotype of blasts at diagnosis in peripheral blood samples. A) CD45/SSC dot-plot. Blasts are included in P1 population. B) blasts are CD19-positive, with a minority of them (18%) being CD34-positive (Q2 quadrant). Blasts are CD10- and CD20-negative (C) and CD58-positive (D). E) positivity of CD79a. F) blasts are negative for CD13.
Mentions: Manual WBC differential count of peripheral blood showed 90% blasts without morphologic differentiation (Figure 1A), 2% neutrophils, 8% small lymphocytes. Blasts resulted negative for myeloperoxidase stain. Flow cytometric analysis was therefore performed using a wide monoclonal antibody panel and a six-color method: blasts were positive for CD19, TdT, CD79a, CD38, CD58, HLA-DR (Figure 2A–F).

Bottom Line: Karyotype showed the co-existence of three cell lines, with persistence of t(4;11)(q21;q23) and appearance of +8,+12,+13 and two der(4).The patient died because of disseminated intravascular coagulation.This finding suggests a blast cell derivation from a common lymphoid/monocytic precursor leading to a final bilineal acute leukemia.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa;

ABSTRACT
About 5% of adult B-cell acute lymphoblastic leukemias (B-ALL) are characterized by t(4;11)(q21;q23), which confers peculiar features to this B-ALL subtype, including a very immature immunophenotype and poor prognosis. We describe the case of a 21-year-old female who presented with B-ALL carrying the t(4;11)(q21;q23) and blasts positive for CD19, TdT, CD79a, CD38, HLA-DR. Before completing the Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) therapy regimen, the B-cell leukemic clone still was detected, but an additional leukemic clone appeared, with morphology and immunophenotype (CD13, CD33, CD64, CD38, CD56, CD15, CD4(dim)) compatible with derivation from the myeloid/monocytic lineage. Karyotype showed the co-existence of three cell lines, with persistence of t(4;11)(q21;q23) and appearance of +8,+12,+13 and two der(4). The patient died because of disseminated intravascular coagulation. Our report describes a rare, possible evolution of such a subtype of B-ALL, with transformation into mixed phenotype acute leukemia in the course of therapy. This finding suggests a blast cell derivation from a common lymphoid/monocytic precursor leading to a final bilineal acute leukemia.

No MeSH data available.


Related in: MedlinePlus